Practice Management Alert

Identify car-crash patients before you treat

You may easily bill the wrong insurance company for a motor vehicle accident (MVA) patient if you don't investigate the patient's coverage and keep in communication with the claims adjuster. Drive down the right road to MVA reimbursement with these six expert tips:

1. Ask if the patient's MVA was work-related. Many jobs require driving, and workers'compensation -- not motor vehicle insurance -- may pick up the tab if an MVA was work-related, says Marvel Hammer, RN, CPC, CHCO, president of MJH Consulting in Denver.

2. Request the name and contact information of the patient's claim adjuster. If the patient says his MVA was not work-related, you should then ask for all pertinent motor vehicle insurance information: name and phone number of claim adjuster, date of accident, claim number, and policy number. If the patient doesn't know all of this information, usually just a claim number is enough to initiate communication with the adjuster, Hammer says.

Bright idea: When a patient calls to schedule an MVA-related appointment, tell him to collect and bring all of his insurance and claim information to the visit.

3. Verify benefits, obtain authorization. Before your physician sees the patient, someone in the billing office should call the patient's auto insurance claims adjuster to verify that the patient has medical coverage and to see if any deductibles apply. You'll want to ask how much coverage the patient has available and where to send the claims, Hammer says. And you should ask what services require preauthorization.

4. Make a copy of the patient's health insurance card. Although the patient's auto insurance may provide coverage at first, benefits can run out and cause you to switch over to billing the patient's private health insurance, Hammer explains. And, some patients may have a deductible with their motor vehicle insurance that needs to be covered by their primary health insurance. Therefore, a good idea is to have a copy of the patient's current insurance information on hand in case you need to start billing that payer.

Keep in mind: If the patient was in the hospital for MVA-related treatment prior to coming to your practice, he may be almost out of auto insurance medical coverage. Most auto plans have a maximum allowable that could be gobbled up by just a few days of inpatient services. Be aware that you may have to switch quickly to billing the patient's private health insurance, Hammer advises.

5. Accept liens with caution. In states requiring the driver at fault to pay for the injuries, the question of a lien may come up quickly, Hammer says. Alien is an agreement with your patient that he will pay for all services when his attorney reaches a legal settlement with the driver at fault.

Be sure you have a signed and notarized document guaranteeing payment in full when the patient receives his settlement, Hammer recommends. Because you may end up waiting a long time -- even years -- for payment, be clear in your written agreement that you will not negotiate your fees later on.

6. Fill out box 10b and 14 on the CMS 1500 form. Box 10b asks if the patient's condition is related to an auto accident. Check "yes." Directly following box 10b is a small space that asks for the place or state. Fill this box in with the two-letter state code for where the patient's MVA occurred. Some electronic claims processors now require you to fill this space if you have checked "yes" in 10b, Hammer says. Box 14 asks for the date of illness, injury or pregnancy. Fill in the date of the accident in this space.

Expect delays: Whenever box 10b is marked "yes," the payer tends to hold the claim and send out a sheet requesting more information from the patient about other coverage, such as auto insurance. This can cause a delay in payment on the first claim while the payer obtains the desired information, Hammer says.